Institutional members access full text with Ovid®

Share this article on:

A complications-based clinical staging of obesity to guide treatment modality and intensity

Daniel, Sunil; Soleymani, Taraneh; Garvey, W. Timothy

Current Opinion in Endocrinology, Diabetes and Obesity: October 2013 - Volume 20 - Issue 5 - p 377–388
doi: 10.1097/
OBESITY AND NUTRITION: Edited by Caroline M. Apovian and Jeffrey I. Mechanick

Purpose of review The current medical model for obesity management is BMI-centric because BMI is the predominant measure used to gauge disease severity, as well as indications for various treatment modalities. Recent advancements in therapy and understanding of the relationship between BMI and obesity-related complications call for a re-examination of this approach.

Recent findings Advancements in treatment, including the recent approval of two new weight loss medications in the USA, have enabled development of new medical models for management of obesity. On the basis of accumulating data demonstrating the benefits of weight loss regarding multiple obesity-related complications (e.g., diabetes prevention, type 2 diabetes mellitus, cardiovascular disease risk, nonalcoholic steatohepatitis, sleep apnea), a complications-centric model is proposed that employs weight loss as a tool to treat and prevent obesity comorbidities. This model assures that the aggressiveness of therapy is commensurate with disease severity, and that therapy is directed at those obese patients who will benefit most from weight loss therapy. The treatment algorithm is comprehensive in addressing complications and quantitative when possible in the staging of risk or disease severity.

Summary A complications-centric approach to obesity management identifies patients who will benefit most from weight loss, and optimizes patient outcomes, benefit/risk ratio, and the cost–effectiveness of interventions.

Department of Nutrition Sciences, University of Alabama at Birmingham, and the Birmingham VA Medical Center, Birmingham, Alabama, USA

Correspondence to Sunil Daniel, MD, Department of Nutrition Sciences, Webb 232, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-3360, USA. Tel: +1 205 996 5243; fax: +1 205 996 9748; e-mail:

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins